Indiana University-Purdue University Indianapolis (IUPUI) / Current evidence shows that sleep-wake disturbances are a persistent problem in women surviving breast cancer. The purpose of this study was to refine the knowledge regarding the incidence, prevalence, and predictive factors of sleep-wake disturbances in breast cancer survivors (BCS) compared to age-matched women without breast cancer (WWBC). The cross-sectional, convenience-sample consisted of secondary data from BCS and WWBC who were recruited by two parent quality of life studies. Subjects were matched within +/- 5 years of age. The sample consisted of 246 BCS and 246 WWBC who were a mean age of 48 years old (SD=8.50), Caucasian (70%), employed (69%), married or partnered (76%), postmenopausal (59%), with a college education (56%), and with at least one concurrent medical problem (95%). Results showed that BCS had more prevalent sleep-wake disturbances (65%) compared to WWBC (55%). The poorest sleepers were BCS, women with hot flashes, poor physical functioning, depressive symptoms, or with moderate or high levels of distress related to a life event. BCS had higher PSQI scores indicating poorer sleep quality and higher sleep disturbances compared to WWBC. Predictors of the severity of poor sleep quality and sleep disturbances were BCS, women with higher number of co-morbidities, women with hot flashes, lower levels of physical functioning, higher depressive symptoms, and greater impact of a life event. Disease and treatment related factors did not predict poor sleep or sleep quality in BCS. Sleep disturbances are a problem in long-term BCS. Knowledge of contributing factors provides useful information during clinical evaluations and treatment of BCS reporting poor sleep. Additional research is needed to determine the impact of poor sleep on quality of life and develop/test effective interventions for long-term BCS.

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Introduction: In 2021, 2.5 million people aged 12 and older abused the addictive psychostimulant methamphetamine (MA) in the US. MA produces short-lasting euphoria, but also anxiety, erratic behavior, mood disturbance, and abnormal wakefulness. Chronic use of MA can lead to disordered sleep, particularly during withdrawal, and clinical studies have shown that sleep dysfunction is a strong predictor for drug-taking relapse. The neuropeptide hypocretin (HCRT) plays a critical role in the transition to a waking state and also modulates drug reward. Enhanced HCRT signaling in the brain underlies the sleep disorder insomnia and the HCRT-receptor antagonist lemborexant has recently been FDA-approved for treatment of insomnia in humans. Thus, in the current study we characterize sleep dysfunction associated with MA vapor withdrawal and hypothesize that HCRT signaling contributes to negative sleep outcomes. Methods: Adult male Wistar rats (N =8) were implanted with a telemetry device and electroencephalographic/electromyographic signals were recorded for 24 hours (12:12 hours, light:dark cycle). Data were analyzed prior to MA vapor exposure (baseline), and during withdrawal (after one week of MA vapor abstinence). Rats were administered lemborexant (0, and 30 mg/kg, in a counter-balanced order) during withdrawal at the beginning of the light cycle. Results: Rats showed a decrease in time spent in rapid eye movement (REM) sleep in the light cycle during withdrawal, and there was a trend for an increase in time spent in REM sleep during the dark cycle, indicating possible REM sleep rebound. There were no changes to non-REM (NREM) sleep or waking in either the light or dark cycle. The number of bouts of REM sleep decreased during the light cycle, and there was no change in average bout duration in REM sleep during withdrawal compared to baseline. The number of bouts of NREM sleep and waking increased during the dark cycle, while the average bout duration decreased during withdrawal compared to baseline, indicating periods of sleep/wake were more fragmented during the dark cycle. In addition, administration of lemborexant restored the amount of time spent in REM sleep and the number of REM sleep bouts during the light cycle. Conclusions: Overall, these findings show there is a role for HCRT neurotransmission in the observed dysregulated and fragmented sleep of male rats during MA withdrawal. Future research should look at gender differences for sleep dysfunction and MA withdrawal, as well as long-term consequences of MA use.

While Attention-deficit/hyperactivity disorder (ADHD) remains one of the most common psychological disorders diagnosed, current understanding of the disorders expression and factors contributing to impairment in early adulthood remains limited. In an effort to better understand current issues with ADHD assessment and treatment in emerging adults, this study aimed to examine relationships between symptoms, executive function (EF), sleep, and impairment. Overall results of this study indicate that together, ADHD symptoms, EF, and sleep account for a significant proportion of variance in impairment. Additionally, results indicate that EF moderates the relationship between ADHD symptoms and impairment, and that sleep may be a protective factor for adults. Specifically, this study found that when compared to individuals reporting more sleep problems, the effect of ADHD symptoms and EF on impairment was much weaker among individuals reporting fewer sleep problems. Understanding the relationship between ADHD symptoms, EF, and sleep is critically important in better understanding adult ADHD and in informing assessment and treatment strategies to more effectively reduce impairment.

Postpartum depression (PPD) remains a serious mood disorder without a known etiology. PPD has a prevalence of 7-15% in the general population. Women with a history of a mood disorder are at an even higher risk for the development of PPD. Work over the last few decades has established a strong association between circadian rhythm and sleep disturbances and mood disorders, such as Major Depressive Disorder (MDD) and Bipolar Disorder (BD). Despite the breadth of evidence associating circadian rhythm disruption and depressive mood episodes, literature establishing a connection between circadian rhythms and changes in mood across the perinatal period is lacking. The work outlined in this thesis aimed to address this gap by examining the association between circadian rhythm and sleep disturbances across the perinatal period and their association with changes in mood in women at high and low risk of PPD development. A total of 87 women were studied, 45 healthy controls and 42 women with a mood history. Women were interviewed during the third trimester of pregnancy and between six to twelve weeks postpartum. Sleep and circadian rhythms were measured using both subjectively with self-reported questionnaires and objectively with actigraphy. Our results show that women at high and low risk showed higher disruption differ in subjective circadian rhythmicity, as well as in both subjective and objective parameters of sleep. Specifically, women at high risk for postpartum were found to have lower sleep efficiency, as measured by actigraphy, in the postpartum. In addition, subjective and objective parameters of sleep and circadian rhythms are associated with changes in depressive symptoms across the perinatal period. Our findings suggest that stabilizing circadian rhythms and improving sleep quality throughout the perinatal period can prevent postpartum mood worsening, particularly for those women at greatest risk. / Thesis / Master of Science (MSc)

Sleep disturbances have been observed across the entire psychosis spectrum. Research has begun to focus on the clinical high risk (CHR) period for psychosis, as the presence of sleep disturbance can be examined separately from the effects of antipsychotic medication and is potentially a risk factor for later psychosis. Several studies have demonstrated a link between sleep disturbance and worsened positive symptoms in CHR individuals. However, sleep disturbance is not unique to the psychosis-spectrum and is well documented in individuals experiencing dissociation. Transdiagnostically, dissociation has been associated with poorer outcomes and reduced treatment response. Despite the established associations between these variables, their respective contributions to positive symptom severity in the CHR period has not yet been characterized. This study examined the separate and combined contributions of sleep quality and dissociation on positive symptom severity in a cross-sectional sample of individuals identified as being at CHR for psychosis. Hierarchical linear regression was conducted to examine the independent and additive influence of sleep quality and dissociation on unusual thought content, suspiciousness, and perceptual abnormalities. Finally, logistic regression was used to determine if sleep quality and dissociation increase odds of a CHR diagnosis. Analyses of indirect effects revealed a significant indirect effect of sleep disturbance on perceptual abnormalities through dissociation in the CHR group. In addition, both sleep disturbance and dissociation significantly contributed to a model predicting to perceptual abnormalities, also in the CHR group. In the total sample, both sleep quality and dissociation significantly increased the odds of a CHR diagnosis. These results suggest that dissociation plays a significant role in the sleep-attenuated positive psychotic symptom relationship in the CHR period, and as a result, could be a modifiable treatment target in these individuals. / Psychology

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